promoting adherence to medication & treatment · 2011-05-26 · adherence: talk with your...
TRANSCRIPT
Promoting Adherence to Medication & Treatment
Lisa A. Razzano, Ph.D., CPRPLisa A. Razzano, Ph.D., CPRPAssociate Professor of Psychiatry Associate Professor of Psychiatry
Marie M. Hamilton, LCSW, MPHMarie M. Hamilton, LCSW, MPHSenior Program ManagerSenior Program Manager
UIC Department of PsychiatryUIC Department of PsychiatryResidency Training Program, Rush-Copley Medical Center
24 November 2010
AcknowledgementsThe UIC National Research & Training Center is funded by The UIC National Research & Training Center is funded by
the U.S. Department of Education, National Institute on the U.S. Department of Education, National Institute on Disability & Rehabilitation Research and the Substance Disability & Rehabilitation Research and the Substance Abuse & Mental Health Services Administration, Center Abuse & Mental Health Services Administration, Center for Mental Health Services, Cooperative Agreement for Mental Health Services, Cooperative Agreement H133B100028. H133B100028.
The UIC MAPS (H133G010093) and UIC MAPSThe UIC MAPS (H133G010093) and UIC MAPS--2 2 (H133G060224) studies are funded by the U.S. (H133G060224) studies are funded by the U.S. Department of Education, National Institute on Disability Department of Education, National Institute on Disability & Rehabilitation Research Field& Rehabilitation Research Field--Initiated Grant Program. Initiated Grant Program.
The views and ideas expressed herein do not reflect the The views and ideas expressed herein do not reflect the policy or position of any Federal Agency.policy or position of any Federal Agency.
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Six Ongoing/ Focal Areas for Healthy People 2010 –
According to HHS & CDC
All require adherence to regular screening/intervention regimens, treatment regimens
1.
Infant Mortality [prenatal care, maternal health]2.
Cancer Screening & Management3.
Cardiovascular Disease (CVD)4.
Diabetes5.
HIV Infection/AIDS [was new]6.
Immunizations [was new]
Healthy People 2020 under development:http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.a
spx
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Poor Medication Adherence
Costs $177 Billion in U.S. annually
Accounts for 78% of healthcare spending
20-25% of employer healthcare costs are the result of non-compliance
Cuts across age, gender, race, education and income
Effective adherence programs may have a much greater impact on patient health than improved medical treatments
WHO report revealed that 50% of patients
with chronic disease do not take their medication as prescribed
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Illness & Death in America
7 out of 10 deaths among Americans each
year are from chronic diseases –
not able to maintain regimens for prevention, as well as to adherence to treatments
In 2005, 133 million Americans –
almost 1 out
of every 2 adults –
had at least one chronic illness.
About 25% of people with chronic conditions have one or more daily activity limitations
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Adverse Effects
Heart disease, cancer and Heart disease, cancer and stroke account for more than stroke account for more than 50% of all deaths each year.50% of all deaths each year.
Obesity has become a major Obesity has become a major health concern. 1 in every 3 health concern. 1 in every 3 adults is obese; and almost 1 in adults is obese; and almost 1 in 5 youth aged 6 5 youth aged 6 --
19 is obese 19 is obese
(BMI (BMI ≥≥
95th percentile of the 95th percentile of the CDC growth chart) CDC growth chart)
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Adverse Effects
For diabetes, hypercholesterolemia and hypertension, hospitalization rates were significantly lower for patients with high medication adherence.
Diabetes continues to be the leading cause of kidney failure, nontraumatic
lower-extremity
amputations, and blindness among adults, aged 20- 74.
Example: Diabetes Regimen Adherence
Each additional $1 spent on diabetes medication is estimated to save $7 in medical costs
Combined drug and medical costs for the most compliant diabetes patients average almost 50 % below the cost for the least-compliant group
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Costs of Poor Adherence
Represent 75% of total health care Represent 75% of total health care expendituresexpenditures
69% of hospital admissions 69% of hospital admissions
80% of hospital days 80% of hospital days
55% of emergency room visits55% of emergency room visits
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Depression affects adherence & is mot common co-morbidity worldwide
(WHO 2003)
0%5%
10%15%20%25%30%35%40%45%50%
Hypert
ensio
nHea
rt Atta
ckEpile
psyStro
keDiab
etes
Cance
rHIV/A
IDS TB
Genera
l Pop
HypertensionHeart AttackEpilepsyStrokeDiabetesCancerHIV/AIDSTBGeneral Pop
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Health Beliefs
One strategy to promote adherence is to One strategy to promote adherence is to address health beliefs in several areasaddress health beliefs in several areas
Perceived SeverityPerceived Severity
Perceived BenefitsPerceived Benefits
Perceived BarriersPerceived Barriers
Cues to ActionCues to Action
Self EfficacySelf Efficacy
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
General HBM ApplicationConcept Definition Application
Perceived Susceptibility
One's opinion of chances of getting a condition
Define population(s) @ risk, risk levels; personalize risk based on a features/behaviors; heighten perceived susceptibility if too low
Perceived Severity
One's opinion of how serious is a condition, its consequences
Specify consequences of the risk and the condition itself
Perceived Benefits
One's belief in the efficacy of the advised action to reduce risk or seriousness of impact
Define action to take; how, where, when; clarify the positive effects to be expected.
Perceived Barriers
One's opinion of the tangible and psychological costs of the advised action
Identify and reduce barriers through reassurance, incentives, assistance.
Cues to Action Strategies to activate "readiness"
Provide how-to information, promote awareness, reminders.
Self-Efficacy Confidence in one's ability to take action
Provide training, guidance in performing action.
Using HBM: Medication & Treatment AdherenceConcept Application Tailoring Activities
Perceived Susceptibility
Define patient’s @ risk, risk levels; probability of perceived susceptibility & progression; features & their health behaviors;
Increase overall knowledge of disease progression risks; 2
illness risks; potential med interactions; metabolic issues
Perceived Severity Specify consequences of the risk and the condition itself
Initial symptoms & limitations; long course impact of illness, complications of poor treatment
Perceived BenefitsDefine action to take; how, where, when; clarify the positive effects to be expected
Increase function reduce impact; initiate use of medications (e.g. HIV/AIDS);
Perceived BarriersIdentify and reduce barriers through reassurance, incentives, assistance
Medications/interactions; identifying early symptoms, side effects; cost
Cues to Action Provide how-to information, promote awareness, reminders
Illness monitoring; conversations with docs
Self-Efficacy Provide training, guidance in performing action
Development of regimen dosing plans; health testing routines; treatment schedules
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Strategies to promote adherence
PERSONAL
understanding of perceived susceptibility, seriousness, & benefits for action
Identify patients’
strengths & weaknesses –
core principle of PSR/EBPs/EBM
Translate technical information to formats usable, & preferred & understood by patients
Must identify systemic barriers, tangential systems with opportunities for integration
NORMALIZE health promotion –
regular messages are less suspicious, coordinate with community programs, variety to promote attendance
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Suggestions from CDC: Suggestions from CDC: Before you begin any treatment regimen, there are
several steps you can take to help you with adherence:
Talk with your healthcare provider
about your treatment plan and develop a plan that works for you.
Be sure you understand why adherence is so important. When you know the possible consequences if you don’t adhere to your treatment plan, you may be more motivated to stick with it.
Get a written copy of your treatment plan that lists each of your medications and describes how and when to take them.
Learn all the possible side effects of your medications
so that you know what to expect and how to manage any problems.
More CDC Tips
Adherence is harder when dealing with life challenges, like substance abuse/alcoholism, unstable housing, mental illness, relationship issues, or other issues. Talk to your doctor about any challenges you may be facing that could affect your ability to take your meds.
Consider a "dry run." Use candy or vitamins to practice your treatment regimens when complex.
Schedule taking your medications around your daily routines. That can make it easier to remember and stick to your regimen.
Ask your provider about stopping treatment
- treatments should only be stopped or started as
agreed upon with your care provider.
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Ex. Prescription Adherence Tools
You have just filled a prescription for an You have just filled a prescription for an antibioticantibiotic……
READ THIS IMPORTANT INFORMATION
Take it exactly as your medical expert tells you
Do not skip doses
Do not share it with others
Finish the prescription even if you feel better
Do not save it for later
Why is this checklist so important? Using an antibiotic the wrong way can make infections stronger and harder to treat. You can prevent this problem by getting smart about antibiotics.
For more information call 1For more information call 1--800800--CDCCDC--INFO or visit INFO or visit www.cdc.gov/getsmart/
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
FDAFDA’’s Safe Use Initiatives Safe Use Initiative www.fda.gov/Drugs/DrugSafetywww.fda.gov/Drugs/DrugSafety
Safe Use Initiative aims to create and facilitate public and private collaborations within the healthcare community.
Central goal is to reduce preventable harm by identifying specific, preventable medication risks and developing, implementing and evaluating cross-
sector interventions with partners who are committed to safe medication use.
Adherence Follow Up Questions for 1:1 Meeting with Patients
Questions that should anchor every visit: 1. How many doses did you miss?2. Have you had any other
doctor’s
appointments since I last saw you? How did it go? What happened?
3. When is our next appointment?
Razzano et al. UIC MAPS Program.
MAPS-1 Findings
Medication intervention based on health beliefs and other theoretical models –
evaluated in small RCT study
Results examine baseline (T1) and 6-month follow up (T2) data
Intervention group (MAPS) demonstrated stronger improvement in adherence in contrast to comparison group (CG), p< .02.
Impact:
Missed dosages decreased by 59%
among MAPS participants vs. 26% among CG participants (+33% MAPS
vs. CG).
Razzano, Hamilton et al. UIC MAPS Program.
MAPS-1 Findings
The MAPS participants also reported significant improvements related to physical HIV/AIDS symptoms compared to the CG, p< .01
Impact:
reported impairment related to
HIV/AIDS symptoms* decreased by as much as 50% for MAPS compared to 28% in CG. (+22% MAPS
vs. CG)
* Health Symptoms = positive correlate with adherence
Razzano et al. UIC MAPS Program.
Early Results from PeerEarly Results from Peer--Operated Operated MAPSMAPS--2 Intervention2 Intervention
Percent of pills missed in the last 7 days was an HIV medication adherence indicator
There was a significant (p=0.002) decrease in percent of pills missed over time
The mean difference in percent of pills missed after controlling for confounders was:
-
6.79% from baseline to post (p=0.032) &
-10.48% from baseline to follow-up (p=0.002).
Razzano, Hamilton, Perloff et al. PASHN Program.
Razzano, L.A. & Hamilton, M.M. (2010). Razzano, L.A. & Hamilton, M.M. (2010).
Lisa A. Razzano, Ph.D., CPRP (312) 413Lisa A. Razzano, Ph.D., CPRP (312) [email protected] M. Hamilton, LCSW, MPH (312) 413Marie M. Hamilton, LCSW, MPH (312) [email protected]
Center on Mental Health Services Research & PolicyCenter on Mental Health Services Research & PolicyDepartment of PsychiatryDepartment of Psychiatry1601 West Taylor Street, M/C 9121601 West Taylor Street, M/C 912Chicago, IL 60612Chicago, IL 60612(312) 355(312) 355--0753 (FAX)0753 (FAX)www.psych.uic.edu/cmhsrp